Loading...
ENC2008-00037CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 060-2150 Fax (408)376-0958 ENC' ``SCHMENTPERMIT (far ng within the public right-ol-way) n ( ~ (~, issued Permit Expiration Date, ~'~ j~~~ Permit Nr X-Ref. i Application Date =~ ~~ fz _ Application Expiration Date_ ~ ~ l f /Cj~ APN APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work address or tract #, Utility trench B. Nature of wor l:, C. Attach four (4) copies of an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. '1, L~ Name of Applicant ~~~ ~~~ ~- Telephot~~ /~~ ' ~ `~~ rint ame Address , D21~' ~~ F~ '~~- • ~,~~}~-~ ~ ~ ~~ 24-HOUR EMERGENCY TELEPHONE NO. .Gi ~A~{~ E-Mail Address ~~ ~ 4-]~~+'~r' ~G r ~t ~,-- ~t`~ Is this work being done by the property owners at their own residence? Yes ~_No The ApplicanUPermittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The ApplicanUPermittee hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their contractor(s) of [he information. Applicant is dvised t on issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out ~ the gon Any ate provements in the public right-of-way. l ///% ?~~,1©8 ~~~ ~ (Applicant Permittee) (sign) Contractor (Print Name) Date SPECIAL PROVISIONS _] . Street shall not be open cut for underground installations. Minimum cuts >~ be allowed for connections or exploration holes. Such cuts may / be specifically annroved by the Inspector prior to cutting. 1% 2. Pavement may be cut far underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A", unless otherwise approved by Inspector. _3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department before starting work. ~4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. _5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be recorded. _6. Public Notification Requirements: _7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MAT~RIALS CONSTRUCTION CASH DEPOSIT ~,~ `~~_~ PLAN CHECK & INSPECTION FEE APPROVED FOR ~~~~ ~ ~~~ ~~A c~~. ~~l`'-~ $ ~1 {v $~, G'~L 1 E C~~ RECEIPT N0. , ~- For city Engineer ~ Date Permit Expires 12 Months After Date of Issuance r._ .A...._ _ F ~., sk QtI _ P.nr77C~Gt'l AMOUNT ,rc ~~ ~t~ `~v r ~~~ ~ E~~t. ' ,~•; , S'Tac~ C ~ c ~ ~~~~~~~ ~~ORD.~-~ V~~~I~I~~~~ a~ ~Ir~~Ii1~~~~ ~~~~~F"v~~~ DATEIMMIDDIYYI e/1s/2oo; PRODUCER ALL SPECTRUM INSURANCE BROKERS 1208 E ARQUES AVE. STE#108 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SUNNYVALE CA 94085 i (4O8) 739-5300 - ll _ INSURERS AFFORDING COVERAGE - - _ wsuRED INSURER A. American States Ins Co _ _ ' Able Underground Construction, Inc _ RD American Home Assurance Co _ _ __ __ ,INSURE aka Able Septic Tank Service __ _ _____ ___ INSURER =_ P.O. Box 24819 __ _ I INSURER D _ _ __ _ _ San Jose CA 95154 wsuRER e. ~.vvcrtrww THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABGVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ _ _ __ INSR LTR TYPE OF INSURANCE POLICY NUMBER ~ ~ ICY EFFECTIVE POLICY EXPIRATION DATE -MM/DD1YY DATE MM/DD/YY LIMIT S I I GENERALLIABILITY _ I ~ t EAChI OCCURRENCE - - - $ 1.000,000 --~--- ----- X I,OP.9P:iERCIAL GENERAL LIABILITI' j ~ I FIRE DA tAC'E IAnv xt _. fir: 1 R 300,000 _ __ CLAIMS MADE X OCCUR I PIED EhP(Any one per»il $ 5,000 g ~ 1594745 ; 6/19/2007 5/1/2008 ~ PERSONALr><ADVINJURY ~ _ 1 000,000 ___... -- -- ---- - --- I I GENERAL AGGREC'ATE 2 OOO A00 E LIMIT APPLIES PEF;: ~ GEN L Ar'('REGAT .-_ o ~ ~ ' ' ~ ~ F'P.ODI ICT9 U(,f-APB IF AGG r .-_ _ __._ . _-___ $ 2 OOO,OOO __.-. ._-.- 'i PRO- X POL~~Y JECT i i LOC'. I AUT OMOBILE LIABILITY ~ I (,OPABINED SINGLE LIPa IT £ 1 000.000 I ~ i (L i ja idenn __ ! ANY AUTO r I ...._ __-.__.. I ALL OWNED AV'TOS ~I i BODILY INJURY ~ A ___ X - SCHEDULED AUTOS ~ ~ 01CH374409 3/31/2007 3/31/2008 (Per per or -- --- --- -- X HIRED AUTOS I BODILY INJURY ~ I X OWNED AUTOS NON . ! (Pvr accidents i - I i I ~ ~PERTY DAb1AGE - -- - ~ i I (Per a~ iilenq ~ ~ AUTO ONLY - EA ACCIDENT GARAGE LIABILITY ~_ i I, _._-_- _-_-..__--_.....L __ ANY AUTO 7 OTHER THAN CA 'A~'~' $ AUTO ONLY: AGG $ I EXCESS LIABILITY ~--~ I I ,EACH OCCURRENCE $ C !; OCi;UR ~I i;LAIIdS P:IADE t , I I i ~' ~ AF GRLGATE __ _ ~ _ .. _ Y _ _ y I i, DEDUCTIBLE i i { __ _.- t- - I--__ - _ ~ ----- RETENTION S I ll I C WORKERS COMPENSATION AND we ATL- o H- Tr?RY LItv11T5 i ER ~~ I ~--- -~~ ~---~-~-~ EMPLOYERS'LIABILITY I EL EACH ACCIDENT a ~ I ~ E L. DISEASE - EA EMPLOYE $ I E.L. DISEASE-POLICY LIMIT $ OTHER i DESCRIPTION OF OPERATIONS/LOCATIONSN HICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS '(A & B) All work in public right of way, City of Campbell. The City of Campbell Redevelopment Agency, its officers, employees and volunteers. Policies are primary over any other collectible insurance. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN City of Campbell NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 70 N 1st Street REPRESENTATIVES. AUTHORIZED REPRESENTATIVE """~` ~ ' ~~ Campbell CA 95008 ACORD 25-S (7/97) -~""""." ""~` "'""' '~ '""" LM' LPN. v?.9.8 on ur13107 - 11'31 by UserName LF. LPW vt9.fl nn G!18rC7 - 1 ?:32 Uy User'rJama PF v1 _G.1 Vk+ES.~ V~-i_.E`'" ~kld! I ~TIO~' DlSTRIC rv__ ~ n 100 ~. OunnyoaKS Ave., ~ampoel~, i:,l-~ 950(Jo i 4031 378-2407 LOCATION: Sewer Location: Bk. Pg• j ~ Tract -Lot Proj: Assmt ~L~• Address : ~ ~ ~ '~ ~~ ~~'.~-~~~ ~~ ~.wiW i1~L~~ - Jurisdiction r f~ Nl ~ i~,r/ 1...1..- BUILDING TYPE: Single Family Condominium/Town Houses Multiple Dwelling Number of Units Commercial Industrial C.. C' ~: ".L. C... Other Information: •= 1~'~'",A1+1T'~t:~h1Cti/~I~,.1*l ti ..;...~I';; ~~u- !. i/ Change in Status: ' WHITE :PERMIT /PINK. - FEES: Acreage $ , .. Service Advance ~ 1 ~ a Processing r'~ll~ '~ Other: ~ I L{~ ~~' ~. Capacity TOTAL ~l`~f~~~ Issue ~„ce _._. BUILDING SEWER CONNECTION: ~~' Feet -~'~ of ~ Property line feet from Main Sewer and ~ feet deep. ~~ Connection to Main $evyer O ,~ cj M ~ - Feet upstream from-M.H. ~- Using BACKF LOW:.F'FiOTECTION: ~_ Field-check Required Call District for foundation survey Disposition; GO Zone RL SJ Device Required; Yes '~' No~ ~~ TYPe: /"~ a~~~ INSTRUCTIONS: ~ J~ e Street encroachment permit required from / o Permit invalid if not connected within 12 months of issue. o Do not connect until main sewer is .accepted by District. o Obtain a building or plumbing permit from the jurisdiction listed above. a L c rv 3.~u: c. z ~ .: :ia 't1 ea,`Z..c- ~ w.'"~ F' ~ ~ r l +.a ni ~.„ ~ r..~ y t Ol.:>t..'i t ~1 u"r ~~~ s",-MS T~? It 7.3'1 CT /YELLOW - JUF -- BACKFLOW DATA 1) Previous determination made: 2) Field check required: 3) Main sewer size: inches 4) Building sewer is ft from upstream MH/riser. 5) Elevation upstream MH/riser: ft 6) Ground elevation at edge of easement or property line: ft 7) Difference ir, elevation between no. 6 above and elevation of lowest floor with plumbing: ft 8) Elevation of lowest floor with plumbing ft 9) Difference in elevation between lowest floor with plumbing and upstream MH/riser: /~ D+ ft 10) If MH/Riser is higher than floor elevation a backflow protective device is required. 11) Minimum (H) from table required for overflow device 12) Available location for overflow device: 13) Minimum H available @ device location: SEWER CONNECTION °` ~"".~ ~`' G G t'~• ~,R I T n! IJ n~ R F G M,7 Y.~ ,..,. ~' ~~. ft 14) Type o backflow protective device required: ~DN~ 15) Determined by % 6/~ Date t Z- f3' ~ 16) Notice to Permittee TION BUILDING INSPECTOR'S COPY /CARD ~ rA ~ ii~SN~~iaY ~.'~.tSciLO'~i^ REMARKS: T COPY PUBLIC WORKS DEPARTMENT UTILITY ENCROACNMtN I ~ mIJC:tLLP-IV000J r[~~.~~r i Effective July 1, 2007 TO: City Clerk ~ - ~, ~--;,- PUBLIC WORKS FILE NO. ~~ ~- "~~~ ~'~'~ ~~~ PROPERTY ADDRESS ~ ~` ~ iV~ ' Please collect & receipt for the following monies: ACCT. ITEM AMOUNT ENGROAC HMENTPERMIT ' - _ "'- flea ion ee I I ncroac m~-Permi~p nt Permit h E 00 $300 me ncroac on- I I rmit < $10 000 t P h . ($135 00) . e men Minor Encroac 00 e Subse uent < $10 i $135 it N F i P o e erm rst R-1 F r Street t ll l/C A i . $560 00 ec o o rter a Utilit r Areas t/Oth l St i . $310 00 O e ree Resident a r's Estimate i f E i 2% . $500 min * 2203 nee n t o Plan Check De os i FPS S 100% of ENGR.EST. ' 2203 ecur Faithful Performance i l S 100% of ENGR. EST. ' 2203 ecur s Labor and Materia it $1000/Monument ' 2203 Monumentation Secur h De osit ti C t C Est $500 min/$10,000 max 4% of En r * 2203 as on ons ruc Emer enc Plan Check & Inspection Fee (Non-Utility) < $250 000 E . (13% of ENGR.EST.) 4722 ** Engr st 250 000 > Actual Cost + 2o%/Min. $30,000 De osit 2203 En r. Est. $ 00 ~'` 4722 Utilit < $100 0 tion L P h 00) ($250 oca er arge Minimum C 500 Feet t li Pi . 25/ft) ($2 o nes up pe Conduits/ t F 00 Li . 35/ft) ($1 near ee Above 5 /Et lt N . 00/ea) ($125 c s au Manholes l . 00/ea) ($125 Pole Set/Remova moval /R ti Pl T . $145 00 ** e an n ree Street 000 . Actual Cost + 20% " ' 2203 Utili > $100 it i P $125 00 4760 erm ner Stora a Conta ti ifi ' . Pro'ect No 4760 . ons ca ect Plans & S ec Pro 50/Bk tails $1/P $15 & D ti ifi 4760 e ons ca Standard S ec & Plans M ri i . 4760 a s n nee Co ies of En 36" " $54 00 x Aerial Plot 24 11" 1/2" . 00 $25 x Aerial Print 8 h F . 00 $25 ee Aerial Searc 36" 24" . 00 $12 x Ma sand Plans restore ublic im rovements t F il lti . $100/Calendar Da Muni Code Sec. 11.34.010) 4722 ure o a es: Pena afe conditions t $100/Calendar Da 4722 4722 uns Penalties: Failure to correc Work Without Permits 4 Times A licable Fee MISCELLANEOUS' Other Please S eci *Engineer's Estimate shall be as approved by the City Engineer. ~7 NAME OF APPLICANT ~' ~t~- ~ ~~ ~-- NAME OF PAYOR L~ ~-?~" °1 r~jR} ~~% ~ D ~ ~ C~~ ADDRESS C. TOTAL $ ~ ~ PHONE ,~~ `~~~~ ~p `.~< ~~ ZIP ~~ l7 I S '*Actual Cost Plus 20% Overhead NOn-I terest bearin de osit FOR RECEIVED Y ITY CLERK ONLY ~ n Date Z ei t #, ~.' 'For'Plan Check and Cash Deposits, send yellow copy to Finance. Date/ Initials J ~FCNMTTw~4MwUl~i+ItiMVYUIN Fmn UWry E~nacMrY • 1MC OtL! IEEV. 1N!) PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT & MtSGtLt_Alvtuus rctt,tir I Effective July 1, 2007 TO: City Clerk .y, ;~~~_ ~;L, PUBLIC WORKS FILE NO. ~-~' ~~~ _ ~~'~ .>~ PROPERTY ADDRESS 'I ~` `~ il-~ ' Please collect & receipt for the following monies: ACCT. ITEM `AMOUNT ENCRQAC HMENT'PERMIT _ I I ncroac me~mi pp icaflo Encroachment Permit $300 00 on- I I Encroachment Permit < $10 000 Mi . ($135.00) nor 1 First Permit No Fee Subse uent < $10 + $135.00 R - Utilit Arterial/Collector Street $560.00 idential Street/Other Areas R $310.00 Q es sit 2% of En ineer's Estimate k D Ch Pl $500 min ` 2203 e o ec an mance Securi FPS rf ithf l P F 100% of ENGR.EST. * 2203 or e u a ials Securi t d M L b 100% of ENGR. EST. * 2203 er or an a a ntation Securit M $1000/Monument * 2203 onume Construction Cash De osit E a% of En r. Est $500 min/$10,000 max * 2203 mer env Plan Check & Inspection Fee (Non-Utility) r Est < $250 000 E (13% of ENGR.EST.) 4722 ** nq >$250 000 Est r E Actual Cost + 20%/Min. $30,000 De osd * 2203 . n . Utili < $100 000 _ L'~" 4722 m Charge Per Location Mi im ($250.00) n u elines up to 500 Feet Conduits/Pi ($2.25/ft) p e 500 Linear Feet Ab ($1.35fft) ov ManholesNaults/Etc ($125.00/ea) t/Removal P l S ($125.00/ea) o e e et Tree Plantin /Removal St $145.00 ** re Utili > $100 000 Actual Cost + 20% ** 2203 60 Container Permit St $125.00 47 ora a & S ecifications n t Pl P ' Pro'ect No. 4760 0 a s ro ec rd S ecifications & Details $1/P $15.50/Bk St d 476 an a of En ineerin Ma s & Plans i C 4760 es o l Plot 24" x 36" ri A $54.00 a e t 8 1/2" x 11" l P i i A $25.00 r n er a l Search Fee i A $25.00 er a d Plans 24" x 36" M $12.00 722 a san alties: Failure to restore ublic im rovements P $100/Calendar Da Muni Code Sec. 11.34.010) 4 en re to correct unsafe conditions F il lti P $100/Calendar Da 4722 4722 u es: a ena Work Without Permits 4 Times A livable Fee MISCELLANEOUS` Other Please S eci 'Engineer's Estimate shall be as approved by the City Engineer. '7 NAME OF APPLICANT ~` ~~~ ~ ~ fad L-- TOTAL $ ~ ~ R t-~ C~1/ ~1C` NAME OF PAYO PHONE ~~ `c~~~~ ~~ ^ ADDRESS `C l-~ ~~% ~ ~ l ~ C~I-Y" ,~~.-~~- ZIP ~~ r7 ~ 5 ''Actual Cost Plus 20% Overhead (Non-I terest bearing de osit FOR .-- i 'RECEIVED Y ITY CLERK ONLY Dated Z. ei t # ~ 'For Plan Check and Cash Deposits, send yellow copy to Finance. Date/ Initials GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges wiii be made against u`lls deposit if there is au emergency call-out, ovcriimc inspection or when Ciry ordered barricading is required. Any such costs in excess of the deposit will be billed to the Pertnittee. 2. A one-year raintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours and street closures. This plan must be reviewed and approved prior to any lane closures. 7. The Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. 8. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 10. Prior approval of inspector is required for any work done afrer normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 11. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 12. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. ]4. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition to the public. 15. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. l6. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. ]7. This permit is not transferable. Work must be perfotrrred by the Permittee or his designated agent or contractor as specified thereon. l 8. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Ciara Valley Urban Runoff Pollution Prevention Program. 20. If [he public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 21. Permittee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. 3 Zt p~ ate ~~ ; o~ Date J\forms\pwperm Rev. 11 /9/05 Contractor (Print Name) i..i J 'i Ui` i.. tii~f xl~Ll_. ,..n F'r~~`~k: YL~ ;;"1ijEF~iirU~4t~f.j i=u 5,`. ~~.L~1GF lj r'1IL.e VvJ %•r~~l'j?1J! I.l1iL: l.4~u`?~~.... C~i~GF; ~ SUTB`tj I'1 r ZLIi?i~; ~v.%„:i GI~j3f4 .., ._~.}DijT;,I i'~Ti_ii~~+ ~' +c'c~',111~ Fr.: n~~ ~. C... ;,-, TEs'~Ijr_F,Etj: K'+.ii.St1. V~44 / CHf,r1~E: #.~i0 1 ,~ 4 Z i i:. ______ ~,;~ '~J ~~ ~„ ~z a O ~ ~ L.d "'.~ ~ «.,..,, _~ ~~ ~ .~ III o 0 ~ ~ ~, '~`~ ,,,.. '~ ~ ~ ~~~ a "~ ~, ..~ °~A ~ S~ ¢ .mow ~ r~ p; ~ + ~' 'a F , y~. w _~ '''S° ~" o ~,,,~ ~. . ~ p~ p ~.R. V ~ ~~ ~~ ~ COVERAGES ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING Y BE ISSUED OR O A THE P L TE MA TERM OP. CONDITION OF ANl' CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIC QUIREMENT TIONS OF SUCN R . ANY E THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDI MAY PERTAIN . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICIES . POLICY EFFECTIVE !POLICY EXPIRATION LIMITS R TYPE OF INSURANCE I POLICY NUMBER DATE MMIDDIYY I DATE MMIDDIYY I LT I GENERAL LIABILITY EACH OCCURRENCE $ I I I I COIv1N1ERCIAL GENEP.AL LIABILITY I FIRE DAMAGE IAny one fuel $ i ~I-- I CLAIMS PAADE ~ OCCUR I N1EU EY,P (Any one Uersonl ~$ PE~ADAr INJUP.Y 4 I h-J - i I I GENEP.AL AGGP.EGATE ~ $'~ I PRODUCTS - COAdP%OP AGG $ EN'L AGGREGATE UI~41T APPLIES PER: ~ PRO- ~ LOC I I l POLICY I i JECT T AUTOMOBILE LIABILITY I $ COMBINED SItJGLE LIt~41 (Ea acadenti ~~ ANY AUTO I I Y Y INJUP D I I ALL OWNED AUTOS ~ $ . IL BO ersonl ~ {Pe ~~ I (SCHEDULED HUTOS i ~ r p ~ HIRED AUTOS ~ i 50DILY INJUPY ~ $ I (Per c~CGI(letlt I NON-OWNED AUTOS I I ~~ _ --~- II j PP.OPERTY DAPdAGE $ leer 2cadentl I I I AUTG ONLY - EA ACCIDENT S GARAGE LIABILITY I ~ I T EA ACC I $ I I ~ GTHER THAN I ANY AUTO I I i I AUTO ONLY: AGG I$ EXCESS LIABILITY I I I EACH OCCURRENCE $~ AGGREGATE I$ . OCCUR ~ CLAIMS PAADE ~ _ } -~ I ~ $ -__ I I II $ DEDUCTIBLE I I I RETENTION $ I I I $ ~ X I O WORKERS COMPENSATION AND IABILITY I ' ER ORY LIM TS EACH ACCIDENT $ 1 .000.00 E L L EMPLOYERS i, A I W C: 7596209 ~ . . I 5! 1!2007 I 5/1 /2008 I I I, E L. DISEASE - EA ErEA Et,4PL0YEE $ 1,000,000 i ~ I I I E.L. DISEASE- POLICY LIMIT $ 1 ,~~~,000 OTHER I I I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEM ENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONALINJVKtU:IrvJUttcrt~ciicn _ ...+,.~.~~~r,~-~-•- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN City of Campbell NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Public Works Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 70 N 1St Street REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - ~ _ ~ Campbell CA 95008 ,~_ .-=~-~~-- --_ ___~""' I -' `:r,~;G,f_i5F2D CORPORATION 1988 ACORD 25-S (7197) " PF ~~:.a r Lt 9: LPW v1.9.8 nr~ s'1!07 - 14 40 by UserName LP: LPW v1.9.S on S~ii07 - 14:41 by UserN2me